UMEM Educational Pearls

Category: Pharmacology & Therapeutics

Title: Fluids are Drugs

Keywords: fluid, saline, chloride (PubMed Search)

Posted: 7/22/2013 by Bryan Hayes, PharmD (Emailed: 8/3/2013) (Updated: 8/2/2013)
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A recent review identified 5 key points to consider when prescribing fluids.

  1. Fluids should be prescribed as drugs, recognizing that any fluid can be harmful if dosed incorrectly.
  2. The differences in efficacy between administering a 'crystalloid versus colloid' are modest; however, the cumulative differences in safety appear more significant.
  3. The qualitative toxicity associated with hydroxyethyl starch (HES) and isotonic saline remains a concern.
  4. The differences in chloride load and strong ion difference between cystalloid solutions, such as isotonic saline compared with physiologically more balanced solutions, appear to have clinical relevance.
  5. The 'default' resuscitation fluid for acutely ill patients should likely be physiologically balanced crystalloid solutions (eg, PlasmaLyte or Ringer's lactate ).


Raghunathan K, et al. Fluids are drugs: type, dose and toxicity. Curr Opin Crit Care 2013;19(4):290-8. [PMID 23817025]

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